Am J Psychiatry 1996; 153:1028-1036
Copyright © 1996 by American Psychiatric Association
Winter seasonal affective disorder: a follow-up study of the first 59 patients of the National Institute of Mental Health Seasonal Studies Program
PJ Schwartz, C Brown, TA Wehr and NE Rosenthal
Clinical Psychobiology Branch, NIMH, Bethesda, MD 20892, USA. oschwart@box-p.nih.gov
OBJECTIVE: The purpose of this study was to characterize the long-term
course of patients with seasonal affective disorder. METHOD: The first 59
patients with winter seasonal affective disorder who had entered winter
protocols were retrospectively followed up after a mean interval of 8.8
years. Detailed life charts were constructed through use of a
semistructured interview and collateral records. RESULTS: The disorder of
25 patients (42%) remained purely seasonal, with regular recurrences of
winter depression and no depression or treatment through any summer. The
course of illness was complicated by varying degrees of nonseasonal
depression in 26 patients (44%). The disorders of eight patients (14%) had
fully remitted. Certain features of the group with complicated seasonal
affective disorder suggested that they were more severely ill. Twenty-four
patients (41%) continued to use light treatment regularly throughout the
follow-up period. Light treatment was preferred to medication for winter
recurrences, although antidepressants had been used in the winter by most
(63%) of the patients who still used lights at follow-up. CONCLUSIONS: The
pattern of winter depressions and summer remissions remained fairly
persistent over time in this group of patients. The temporal distribution
of depressive episodes both within and across individual patients was
consistent with the results of several recent follow-up studies of seasonal
affective disorder, providing support for the predictive and construct
validity of the Rosenthal et al. diagnosis of winter seasonal affective
disorder. Light treatment, while remaining a safe and satisfactory
treatment for many, may be insufficient for more severely ill patients. The
appearance of nonseasonal depressions in patients with winter seasonal
affective disorder may be associated with greater severity of illness and
less responsiveness to light treatment.
